Provider Demographics
NPI:1255774576
Name:CHURCH OF THE SACRED HEART
Entity type:Organization
Organization Name:CHURCH OF THE SACRED HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DI TULLIO, SDC
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:401-434-0326
Mailing Address - Street 1:118 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4550
Mailing Address - Country:US
Mailing Address - Phone:401-434-0326
Mailing Address - Fax:401-434-1080
Practice Address - Street 1:118 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4550
Practice Address - Country:US
Practice Address - Phone:401-434-0326
Practice Address - Fax:401-434-1080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty